The numbers are staggering: Approximately 23,000 deaths in the U.S. are attributed to infections caused by antimicrobial-resistant organisms every year. Some researchers estimate that the number of annual deaths worldwide caused by these infectious agents could climb as high as 10 million by 2050.
Antimicrobial resistance (AMR) is an “increasingly serious threat to global public health,” according to the World Health Organization, as “superbugs” impede our ability to treat and cure common infectious diseases. AMR describes the phenomena in which bacteria, fungi and/or parasites have evolved to resist the antibiotics created to kill them.
Examples of antimicrobial-resistant organisms include carbapenem-resistant Enterobacteriaceae (CRE), and Clostridioides difficile, both of which the U.S. Centers for Disease Control and Prevention classifies as “urgent” threats. CRE causes an estimated 9,000 infections per year in the U.S., resulting in approximately 600 deaths. The CDC also describes CRE as a “nightmare bacteria” because it is resistant to nearly all antibiotics, including carbapenems, a class of drugs often used as a last resort. C. difficile causes life-threatening diarrhea and is responsible for more than 15,000 deaths in the U.S. every year.
The CDC keeps track of reported cases of CRE outbreaks by state. As of December 2017, all 50 states and the District of Columbia have reported cases of KPC-producing CRE – a specific type of the superbug. Other mutations of the CRE bacterium are less common throughout the country, but significant numbers of cases have been reported. Illinois, for example, reported 109 cases of NDM-producing CRE as of December 2017.
In February 2015, UCLA’s Ronald Reagan Medical Center reported an outbreak of CRE that caused two deaths and five other known infections. Contaminated duodenoscopes exposed approximately 180 patients to the bacteria, according to estimates.
As AMR spreads, mortality rates will rise as life-saving medical procedures that rely on antibiotics will be at risk for failure. If antibiotic prophylaxis for surgical procedures, such as cesarean sections and joint replacements, and chemotherapy were reduced in effectiveness by even 30 percent, the result would be an estimated additional 120,000 infections and 6,300 infection-related deaths annually in the U.S.
Traditionally, antimicrobial stewardship focuses primarily on antibiotic prescription practices – it is estimated 47 million antibiotics are unnecessarily prescribed annually from the outpatient setting. Should the battle against the rapid spread of antimicrobial resistant bacteria require an even more comprehensive approach?
In a series of posts, we’re exploring these questions behind these numbers and in the coming weeks we’ll talk to experts about:
The causes: The continued misuse and overuse of antimicrobials only accelerates the spread of antimicrobial resistance.
Stewardship: The CDC, SHEA, and APIC all provide suggested best practices for antimicrobial stewardship. Do their recommendations go far enough to address the risk from medical devices?
The role of infection prevention: Infection prevention should play a greater role in antimicrobial stewardship.
Challenges and innovations: Reprocessing a flexible endoscope is a long and arduous process, prone to errors. There are, however, some innovations that help curb contamination risk.
Leadership: Typically, physicians who prescribe antibiotics spearhead antimicrobial stewardship, but bedside nurses are just as important to the strategy, especially in the OR and ICU.
Conclusions: Effective antimicrobial stewardship should address all levels of infection prevention and control, including the proper handling of bronchoscopes.